Instructions: Print or hand copy this page, Fill in the form, Mail to the address on the bottom of form


Name___________________________________

Email___________________________________

Address__________________________________

City/State/Zip____________________________

Phone # :_____________________________

Payment: [ ]Check [ ]Money Order
[ ] Master Card [ ]Visa [ ]Discover

[ ]American
Express

Card No:___________________Exp.______

Signature:_____________________________
Order Information
Item Price Shipping Total
EluSun




1 Package
2 Packages
3 Packages
 $16.95
$28.81
$41.69

$3.75
$3.75
$3.75

 $20.70
$32.56
$45.44
 
 

Mail or fax form with credit card number, check or money order to:
 Ordertron
P.O.B.335
Cedarhurst, NY 11516

TEL: 516-532-7464


FAX: 413-460-2932